Martin's Point Physician Offers Tips on Managing Seasonal Affective Disorder

BEYOND SAD: BEATING SEASONAL AFFECTIVE DISORDER

By Cathra Chappelle, M.D.
Martin's Point Health Care

Most everyone gets the winter blahs once in awhile. But for some people, a form of depression called seasonal affective disorder (SAD) descends during the dark winter months.

Triggered by the decrease in daylight hours, SAD symptoms are similar to clinical depression and usually appear in late fall, worsen through the winter and disappear with the return of sunshine in the spring. SAD may afflict more than 10 million Americans, and is four times more common among women, many of whom first see signs of the illness in their early twenties.

Sufferers find themselves wanting to avoid contact with people, sleep either too much or too little, and gorge on sweets and other carbohydrates. Unplanned weight losses or gains are also common, as is fatigue and a decreased interest in sex. Persons affected by SAD frequently find their thoughts muddled, and have to force themselves to concentrate, venture outside their homes or even maintain daily routines. If you find yourself feeling out of sorts for extended periods this time of year, you should schedule a checkup with your doctor.

SAD, however, doesn't have to leave you paralyzed throughout the long Maine winter. With the assistance of the Martin's Point Health Education Center in Portland and my own experience as a family-practice physician at Martin's Point, we've compiled a series of suggestions to help ease the symptoms of SAD and get you back on the a positive path:

- Let There Be Light. Exposure to bright, fluorescent light has been shown to counter the symptoms of SAD by tricking the body into thinking it's not winter anymore. Ordinary light bulbs, however, are not strong enough. The light must be at least 2,500 lux - the technical measure of brightness - which is five times brighter than a well-lit office (indeed, the light in a normal living room might be as low as 100 lux.) Treatment typically consists of sitting two or three feet from a specially designed light box, or wearing a light visor that is worn like a cap on your head. Persons with SAD generally begin with 35 to 40 minutes of treatment each morning. For those who have mild symptoms, spending time outdoors during the day or arranging homes and workplaces to receive more sunlight may be helpful.

- Cut the Carbs. Rich, carbohydrate-laden foods seem to intensify the sluggishness associated with SAD. Try to focus on healthy alternatives such as fruits, vegetables and lean meats, and make sure you drink plenty of water, which helps curb appetite. In addition, avoid alcohol - it's a depressant loaded with calories. Women should supplement their diet with a multivitamin with iron.

- Exercise. Studies have long shown that regular exercise fights depression and stress. At a minimum, allow yourself 20 minutes of brisk activity three days a week, whether it's walking, running, swimming, cross-country skiing, weight training, or aerobics. To keep yourself motivated, find a friend who will commit to joining you for a walk or swim, think about exercise as a reward for your body - not a chore.

- Know Thyself. Journal-keeping and meditation can be helpful in identifying factors in your life that contribute to sadness. A better understanding of these issues can put you back on the road to better health. And indulge yourself a little: Snuggling up with a good book in front of the fireplace or a weekend getaway can help nourish the spirit.

- Routine, Routine, Routine. In the fog of depression, maintaining a routine is difficult - but vital. It's not the time to skip regular haircuts, cancel lunch dates or quit your job. (Conversely, it's not a good time to take on new responsibilities.) In short, don't abandon connections with healthy habits and people.

- Make a List. Making a "to-do" list can help keep you focused - and feeling better. Include not only daily tasks, but also healthy actions, such as taking vitamins, eating regular meals, using your light box, journaling, going for a walk, and making contact with other people. In short, keep up with all the important facets of healthy living.

- Talk About It. Talking about your feelings with a counselor or support group can help you identify productive ways to combat SAD symptoms - and reinforce that you're not alone. Therapy sessions also force you to get dressed and out of the house.

Suffering from symptoms of SAD doesn't have to be a fact of life, even during the darkest days of winter. Finding healthy ways to reduce its impact can help bring you back into the light.

Cathra Chappelle, M.D. is a physician at Martin's Point Health Care, the state's largest not-for-profit health care provider with facilities in Portland, Brunswick and Windham, Maine, and in Portsmouth, N.H. She has a special interest in preventative medicine and obstetrics, and accepts new patients and all major health plans. Email Dr. Chappelle at CathraC@martinspoint.org.

LEARN MORE ABOUT SEASONAL AFFECTIVE DISORDER (SAD)

An array of information about seasonal affective disorder (SAD) is available on the Internet and from books. Here's a sampling:

On the Internet
- National Organization of Seasonal Affective Disorder (http://www.nosad.org)
- National Mental Health Association (http://www.nmha.org/infoctr/factsheets/27.cfm)
- SAD Association (http://www.sada.org.uk)
- National Alliance for the Mentally Ill (http://www.nami.org/helpline/sad.htm)

Books
- "Winter Blues" by Norman E. Rosenthal
- "Seasonal Affective Disorder" by Angela Smith, Chris Thompson
- "Light" by Jacob Liberman
- "The Body Clock Guide to Better Health" by Michael Smolensky, Lynne Lamberg
- "Banishing the Blues" by Bruce Charles Barr

Light Products
Sources of therapeutic light products - listed here as a service and not an endorsement - include Bio-Brite Inc. in Bethesda, Md. (1-800-621-5483) and The SunBox Co. in Gaithersburg, Md. (1-800-548-3968).
# # #